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Atrial high-rate episodes and thromboembolism in patients without atrial fibrillation: The West Birmingham Atrial Fibrillation Project.

Abstract：

BACKGROUND:Patients with cardiac implantable electronic device (CIED) developing atrial high-rate episodes (AHRE) have a significant risk of thromboembolic events (TEs), but risk factors have been scarcely investigated. OBJECTIVES:To analyze risk factors for TEs in a contemporary cohort of patients with CIED. METHODS:Consecutive non-AF patients without anticoagulation at baseline were followed up after the CIED implantation. The role of newly-developed AHRE and other risk factors for TEs were analyzed using a time-dependent Cox regression model and Kaplan-Meier analysis with log-rank tests. RESULTS:A total of 594 CIED patients were followed up for a mean of 4.2 years: 175 developed AHRE (29.5%; incident rate [IR] 8.80% per patient-year). Of those, 33 experienced TEs (5.5%; IR 1.38% per patient-year). Incidence of TEs was low in patients with a CHA2DS2-VASc score < 2 (male)/<3 (female) (AHRE vs. no-AHRE, 0.60% vs. 0.00% per patient-year, p = 0.469) and high in those with score ≥ 2 (male)/≥3 (female) (AHRE vs. no-AHRE, 2.12% vs. 1.36% per patient-year, p = 0.209), regardless of the AHRE presence. AHRE was not significantly associated with TEs (hazard ratio [HR], 1.46 [0.64-3.33]). There was no temporal relationship between AHRE and TEs. Baseline CHA2DS2-VASc score was independently associated with TEs (HR, 1.41 [1.13-1.75]) on multivariate analysis, but not AHRE. CONCLUSIONS:Thromboembolic risk in patients with CIED is mainly driven by comorbidity burden, i.e., CHA2DS2-VASc score, rather than AHRE per se. Decision-making on stroke prevention needs to focus on comorbidity burden and not merely on the presence or absence of AHRE in CIED patients.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Li YG,Miyazawa K,Pastori D,Szekely O,Shahid F,Lip GYH

doi

10.1016/j.ijcard.2019.04.055

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

126-130

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(19)31387-7

journal_volume

292

pub_type

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